Cardiology Unit, Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden.
Capio St Görans Hospital, Stockholm, Sweden.
Diabetes Obes Metab. 2022 Jul;24(7):1277-1287. doi: 10.1111/dom.14698. Epub 2022 Apr 19.
To examine how the development of cardiovascular and renal disease (CVRD) translates to hospital healthcare costs in individuals with type 2 diabetes (T2D) initially free from CVRD.
Data were obtained from the digital healthcare systems of 12 nations using a prespecified protocol. A fixed country-specific index date of 1 January was chosen to secure sufficient cohort disease history and maximal follow-up, varying between each nation from 2006 to 2017. At index, all individuals were free from any diagnoses of CVRD (including heart failure [HF], chronic kidney disease [CKD], coronary ischaemic disease, stroke, myocardial infarction [MI], or peripheral artery disease [PAD]). Outcomes during follow-up were hospital visits for CKD, HF, MI, stroke, and PAD. Hospital healthcare costs obtained from six countries, representing 68% of the total study population, were cumulatively summarized for CVRD events occurring during follow-up.
In total, 1.2 million CVRD-free individuals with T2D were identified and followed for 4.5 years (mean), that is, 4.9 million patient-years. The proportion of individuals indexed before 2010 was 18% (n = 207 137); 2010-2015, 31% (361 175); and after 2015, 52% (609 095). Overall, 184 420 (15.7%) developed CVRD, of which cardiorenal disease was most frequently the first disease to develop (59.7%), consisting of 23.0% HF and 36.7% CKD, and more common than stroke (16.9%), MI (13.7%), and PAD (9.7%). The total cumulative cost for CVRD was US$1 billion, of which 59.0% was attributed to cardiorenal disease, 3-, 5-, and 6-fold times greater than the costs for stroke, MI, and PAD, respectively.
Across all nations, HF or CKD was the most frequent CVRD manifestation to develop in a low-risk population with T2D, accounting for the highest proportion of hospital healthcare costs. These novel findings highlight the importance of cardiorenal awareness when planning healthcare.
研究 2 型糖尿病（T2D）患者在最初无心血管和肾脏疾病（CVRD）时，CVRD 的发展如何转化为医院医疗保健费用。
使用预设方案从 12 个国家的数字医疗保健系统中获取数据。选择特定国家的固定起始日期为 1 月 1 日，以确保有足够的队列疾病史和最长的随访时间，每个国家的起始日期在 2006 年至 2017 年之间有所不同。在起始日期，所有患者均无任何 CVRD 诊断（包括心力衰竭[HF]、慢性肾脏病[CKD]、冠状动脉疾病、中风、心肌梗死[MI]或外周动脉疾病[PAD]）。随访期间的结局为 CKD、HF、MI、中风和 PAD 的住院就诊。从代表总研究人群 68%的六个国家获得的医院医疗保健费用，对随访期间发生的 CVRD 事件进行了累积总结。
共确定了 120 万名无 CVRD 的 T2D 患者，并对其进行了 4.5 年（平均）的随访，即 490 万患者年。2010 年之前索引的患者比例为 18%（n=207137）；2010-2015 年为 31%（n=361175）；2015 年以后为 52%（n=609095）。总体而言，184420 名（15.7%）患者发生了 CVRD，其中心肾疾病是最常发生的首发病症（59.7%），包括 23.0%的 HF 和 36.7%的 CKD，比中风（16.9%）、MI（13.7%）和 PAD（9.7%）更为常见。CVRD 的总累积费用为 10 亿美元，其中 59.0%归因于心肾疾病，分别是中风、MI 和 PAD 费用的 3、5 和 6 倍。
在所有国家中，HF 或 CKD 是 T2D 低危人群中最常见的 CVRD 表现，占医院医疗保健费用的比例最高。这些新发现强调了在规划医疗保健时关注心肾疾病的重要性。
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